Evaluation of the Use of Medical Scribes in VAMC Emergency Departments and Specialty Care Clinics
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|ClinicalTrials.gov Identifier: NCT04154462|
Recruitment Status : Recruiting
First Posted : November 6, 2019
Last Update Posted : March 17, 2020
Background and study aims: Medical scribes are trained paraprofessionals that assist providers with documenting patient encounters. Prior evidence suggests that scribes may be effective in increasing provider productivity and satisfaction, and decreasing provider time spent on documentation without negatively affecting patient satisfaction. Section 507 of the MISSION Act of 2018 mandated a two-year pilot of medical scribes, which will begin in March 2020 in specialty clinics and emergency departments (EDs) of twelve VA Medical Centers (VAMCs) across the country. The aims of this study are to understand how the introduction of scribes and scribe training affect provider efficiency, patient and provider satisfaction, wait times, and daily patient volume in the VA context.
Who can participate? Urban and rural VAMCs willing to be assigned medical scribes for use in EDs or selected high wait time specialty clinics (cardiology, orthopedics).
What does the study involve? Four medical scribes will be assigned to each of the 12 VAMC sites randomized into treatment with the VA hiring half as new employees and contracting out for the remaining half. 30% of the scribes will be assigned to emergency departments and the other 70% will be assigned to specialty care. Remaining sites that expressed interest in the pilot but were not randomized treatment will be used as comparators. Provider productivity, patient volume, wait times, and patient satisfaction from the treated sites will be compared to baseline (pre-scribe) data as well as data from comparison sites.
What are the possible benefits and risks of participating? VAMCs where medical scribes are introduced may see gains in provider efficiency, reduced wait times, and increased patient satisfaction due to the shifting of administrative burdens associated with documenting patient encounters in electronic health records from providers to these trained professionals. The introduction of medical scribes could complicate patient encounters by making some patients and/or providers uncomfortable.
Where is the study run from? This study is being coordinated by the Partnered Evidence-based Policy Resource Center (PEPReC) at the VA Boston Healthcare System in collaboration with the VA Office of Veterans Access to Care (OVAC).
When is the study starting and how long is it expected to run for? March 2020 to February 2022
Who is funding the study? U.S. Veterans Health Administration
|Condition or disease||Intervention/treatment||Phase|
|Medical Scribes||Other: Scribes||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||12 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||
A two-arm randomized field experiment is being used to assess the effect of medical scribes on productivity, wait times, and patient satisfaction. OVAC will work with participating VAMCs to identify providers to participate in the pilot. A varied provider pool will limit selection bias but must be balanced with recruitment and retention of providers. The goal is to keep the provider-scribe pairs consistent throughout the pilot.
Each VAMC site randomized to treatment will have two VA employee scribes and two contract scribes. Two medical scribes, ideally one employee and one contract, will be assigned to one physician, with two physicians and/or Licensed Independent Practitioners (LIP) participating at each facility. Scribes will work with others if the provider partner is not available during a scheduled shift. Power analyses have been conducted to determine the minimum effect size for each outcome with 80% power, which will be useful for putting the final results into context.
|Masking:||None (Open Label)|
|Official Title:||Evaluation of the Use of Medical Scribes on Provider Efficiency, Patient Satisfaction, and Wait Times in VAMC Emergency Departments and Specialty Care Clinics|
|Actual Study Start Date :||March 1, 2019|
|Estimated Primary Completion Date :||February 28, 2022|
|Estimated Study Completion Date :||May 31, 2022|
No Intervention: No intervention
The VAMC sites randomized to the comparison arm will not have medical scribes introduced into emergency departments or specialty clinics.
The VAMC sites randomized to the treatment arm are each expected to have four medical scribes, with two being VA employees and two being contractors, introduced into emergency departments or specialty clinics to assist providers during patient encounters.
Section 507 of the MISSION Act of 2018 mandates a two-year pilot of medical scribes in VA specialty clinics and emergency departments. Medical scribes assist health care providers by helping to administratively expedite an episode of care through the recording of patient information and updating patient records. Scribes are trained but non-licensed professionals, often deployed in emergency departments and outpatient clinic settings, that observe and document patient encounters but do not participate in clinical care.
- Pay period work relative value-based provider efficiency [ Time Frame: Approximately 42 months ]Pay period work relative value-based provider efficiency is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
- Pay period visit-based provider efficiency [ Time Frame: Approximately 42 months ]Pay period visit-based provider efficiency is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
- Daily visit-based provider efficiency [ Time Frame: Approximately 42 months ]Daily visit-based provider efficiency is measured using monthly-based provider efficiency, scaled by full-time-equivalent days; this is based on administrative data collected by the VA Corporate Data Warehouse in pay period increments
- Days to completed consult [ Time Frame: Approximately 42 months ]Days to completed consult is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
- Days to scheduled consult [ Time Frame: Approximately 42 months ]Days to scheduled consult is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
- Unique patient volume [ Time Frame: Approximately 42 months ]Unique patient volume is measured using administrative data collected by the VA Corporate Data Warehouse in pay period increments
- Patient satisfaction [ Time Frame: Approximately 42 months ]Patient satisfaction is measured using V-Signals survey data collected by the VA Office of Veterans Experience in pay period increments
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04154462
|Contact: Steven Pizer, PhD||(857) firstname.lastname@example.org|
|United States, Arizona|
|Southern Arizona VA Health Care System||Recruiting|
|Tucson, Arizona, United States, 85723|
|United States, Kentucky|
|Robley Rex VA Medical Center||Recruiting|
|Louisville, Kentucky, United States, 40206|
|United States, Maine|
|Togus VA Medical Center||Recruiting|
|Augusta, Maine, United States, 04330|
|United States, Montana|
|Fort Harrison VA Medical Center||Recruiting|
|Helena, Montana, United States, 59636|
|United States, New Hampshire|
|Manchester VA Medical Center||Recruiting|
|Manchester, New Hampshire, United States, 03104|
|United States, New Jersey|
|East Orange VA Medical Center||Recruiting|
|East Orange, New Jersey, United States, 07018|
|United States, North Dakota|
|Fargo VA Medical Center||Recruiting|
|Fargo, North Dakota, United States, 58102|
|United States, Oklahoma|
|Oklahoma City VA Medical Center||Recruiting|
|Oklahoma City, Oklahoma, United States, 73104|
|United States, Texas|
|Audie L. Murphy VA Hospital||Recruiting|
|San Antonio, Texas, United States, 78229|
|Olin E. Teague Veterans' Medical Center||Recruiting|
|Temple, Texas, United States, 76504|
|United States, Virginia|
|Hampton VA Medical Center||Recruiting|
|Hampton, Virginia, United States, 23667|
|United States, West Virginia|
|Louis A. Johnson VA Medical Center||Recruiting|
|Clarksburg, West Virginia, United States, 26301|
|Principal Investigator:||Steven Pizer, PhD||Boston VA Healthcare System|